Monday, May 12, 2014

A Birth Story Project: Beth

I have the honor of posting another submission to A Birth Story Project. With this project, I provide a public space for birth stories that want to be shared. Please contact me if you'd like to submit your own (anonymous or not, as you prefer). The spectrum of birth experiences is wide, and I'm hoping to be able to post an equally broad variety of stories.

Stories and photos are shared with permission. Stories may be reformatted and edited for clarity, but they are not censored. This is meant to be a safe space, so please read with compassion. Comments may be moderated.

Beth's Third Birth

It was 4:00 am. A familiar sensation brought me out of sleep, though I was not quite awake.  “Great,” I thought. “I started my period.” Suddenly, I was wide awake. “Wait a minute. I’m 28 weeks pregnant. I couldn’t have started my period!” I quickly got up and headed toward the bathroom. It had definitely been something, but I couldn’t figure it out. There was hardly anything there and it had no color, nothing distinguishing. Puzzled, I crawled back into bed. I started to wake my husband, then stopped. He had to get up at 6:00 to get ready for work and I hated to disturb him if I wasn’t sure. I lay there, thinking. When I heard the rustling of my husband getting dressed, I told him what had happened.

He assured me it was probably nothing. “You probably just wet yourself a little,” he said.

“What if it’s amniotic fluid? Remember what happened to your mother?” I said.

“Oh, it can’t be amniotic fluid. It’s way too early for that. Let’s just keep an eye on it,” was his reply.

I agreed and got up to get dressed myself. As I got ready, I wondered if I should call the Birth Center where I had been going for my prenatal appointments. If I called, they may have me come in to be checked, which would be an hour and a half drive. My husband would have to take the day off and I would have to pull my oldest child from preschool -- to potentially be told it was nothing. I put on a liner so that if it happened again, perhaps I would be able to see it better, and vowed to keep an eye on it.

I started our morning routine of dressing the boys, fixing their breakfast, brushing teeth and getting on coats and shoes. I dropped my 3 year old off at preschool and my 2 year old and I came home to decide how to spend our morning. He decided he wanted to make biscuits, one of our favorite things to do together. I got out the flour, baking powder, sugar, salt, butter and milk. We had fun making our biscuits. All seemed to be right with the universe.

In fact, everything seemed to be going well lately. After my last pregnancy, I was a little scared to get pregnant again. My son had been transverse, and despite doing an external version, he never stayed head down. To add to it, I had gestational diabetes and a lot of extra amniotic fluid, which compounded the problem of trying to get him to stay head down once he was turned. I ended up with a C-section, something I had desperately been trying to avoid.

My current pregnancy had started out with a lot of ups and downs. The doctor originally thought the baby was ectopic, and wanted me to take Methotrexate to end the pregnancy. They could not see anything on ultrasound and thought they should be seeing at least something in the uterus at that point. We refused the Methotrexate. We felt we just couldn’t take it when there was no proof the baby was outside the uterus. We wanted to wait to do another ultrasound, as I was still pretty early along. That was a hard week of waiting. I went in for periodic hormone level checks and they did not feel that my numbers were going up fast enough. Another sign, they said, that the pregnancy was ectopic. The doctor gave me a card to carry with me in case I had to go to the emergency room. I was counseled to head there immediately with any pain. I was told the risks to me if I were to have a tube rupture. Amazingly, the next ultrasound showed a little something right where it should be! The ultrasound tech was speechless. We were relieved and elated.

At the next ultrasound, though, the Dr said the sac was not growing as fast as the baby. We were plunged back into a waiting game. Finally, after the first trimester, I switched to the Birth Center in Topeka. We knew the sac was small, but there didn’t seem to be anything that could be done about it. We knew this pregnancy was in God’s hands and there was nothing else we could do but wait and pray. The main reason for the switch, though, was for a better chance at a VBAC [Vaginal Birth After Cesarean]. The hospital in Manhattan [KS] had said I could try for a VBAC, but if I came in when they were busy with a lot of other mothers in labor, I would be sent straight to the OR.

My appointments in Topeka went well. I had another ultrasound at 20 weeks where were found out we were expecting a little girl this time! When I asked about the sac size, I was told there was enough room around the baby. There was a little concern about the placenta being low, but I was told this usually corrects itself. At my last prenatal appointment I found out that I didn’t have gestational diabetes this time around. I was so excited to be able to eat what I wanted. Yes, everything seemed right with the universe. I was starting to be convinced that this time around was going to go so much more smoothly than last time. I do admit to having a few nagging doubts about the VBAC. I knew the chances of something going wrong were low, but if they did, could we live with our decision?

I continued on with my day. I picked up my 3 year old from preschool and the afternoon was full of the business of watching two rambunctious little boys and keeping the house running smoothly. My husband got home from work, excited for a weekend off. We talked briefly about what we would do, as his weekends off are few and far between. I ran to the grocery store to pick up some things to make dinner, and even had to run back home for my wallet which I left on the counter. I was tired from a long day and felt a little scattered.

It was while I was putting away the dishes from dinner that I felt the first big gush. I ran to the bathroom. This time there was a pink tinge. I yelled out to my husband. “Something’s wrong!” I said. When I called the midwife, she told me that my water had probably broken. “Is there anything else it could be?” I asked. At that point, anything sounded better than my water breaking. “No,” she said. She told me to head to Stormont Vail Hospital in Topeka. Thoughts were swirling around in my head. I was trying to figure out the logistics of this with 2 little boys whose bedtime was only an hour away. She asked me what time this started. I told her about what had happened early that morning. “I’m not sure if it was the same thing or not,” I said. “If this started at 4:00 in the morning, you need to get to the hospital right now,” she said.

My husband said he was not driving to Topeka. He would drive me to the hospital in Manhattan, which was about half the distance. I remember being really hurt that he didn’t want to drive me to Topeka. What I didn’t understand at the time was that he was afraid I would go into labor in the car and he thought it would be better if an ambulance took me from Manhattan to Topeka.

Later, a nurse told me that this was really the wisest decision.

The next 20 minutes are still kind of a blur. We tried to decide who to call to help with the boys. We knew it should probably be family, since we would not likely be coming back that night. His family was closest, but we could not get a hold of his parents. I called his brother and sister-in-law next. They have five of their own, but she thought nothing of putting the baby in the car and heading to Manhattan to meet us while her husband watched the other four. We threw some things into a bag for the boys, and in the meantime, I had to change to a heavy pad twice. My husband asked if he should just call an ambulance, but we were pretty much ready to go at that point. We piled into the car and headed toward Manhattan.

The ride was a quiet one. I thought to look for the rosary we usually left in the car, but I couldn’t find it. “One of the boys took it out," my husband told me. I quietly prayed without it, looking out the window. I don’t think it had sunk in how big this really could be. I was just worried about going into labor at that point. Every twinge I felt grabbed my attention. It seemed to take so long to get to Manhattan. The boys were exceptionally good for the ride. When we were close to Manhattan, my oldest said, “Mommy, when you get done at the hospital, let’s get something to eat and go home.” At that point, I had to fight back the tears. I knew I wouldn’t be going home that night.

We finally arrived at the hospital and parked. When I got out of the car, I realized that I had leaked through my jeans. We hurried inside and up to labor and delivery, where they were already waiting for us. The Birth Center in Topeka had called them. It turned out that I was not dilated, thankfully, but a swab test showed that I was leaking amniotic fluid. I was definitely ruptured. I heard the nurse telling my husband that I was ruptured and would have to be taken by ambulance to Stormont in Topeka. I felt like I was in a dream. They then wheeled in a sonogram machine to check on the baby and gave me a steroid shot in the hip. I tried not to think about what that meant. I knew they were trying to mature the baby’s lungs in case she was born early.

By that time, my sister in law had arrived and was helping distract the boys with snacks. I was glad to have someone else there. The doctor came in to do the sonogram and I was told that I had just “bought myself a ticket out of there.” It was agreed that Jeremy would take the boys home and I would go by ambulance by myself and call my Mother to meet me in Topeka. I happened to ask my sister-in-law if she had a rosary. She lent me hers to take with me. It was comforting to hold it during the ride to Stormont Vail and really came in handy that week.

Two men came in to load me onto the ambulance. One of them ended up knowing my husband’s family and we were able to make small talk about that. I don’t even remember which way we ended up leaving the hospital. I just remember being put into the ambulance and driving off. I was so scared that I laid there stiff as a board for most of the ride. I continued praying silently and tried not to think of the boys.

When we arrived in Topeka, I was put in a temporary room to be checked in. The nurse was very smiley and perky, which grated on my nerves a bit. I was terrified. I just wanted the Dr to come in and tell me when they would be delivering. I assumed it would be later that night. The nurse asked a lot of questions and kept saying, “You know we don’t do VBAC’s here, right?” I told her I did. Finally, the Dr came in and told me that I had Preterm Premature Rupture of Membranes. They would be doing a few tests, but he said that usually no cause was found. It was just something that happened sometimes.

I was told that I would be on bed rest in the hospital -- hopefully until 34 weeks. I felt like the world was crumbling down around me. 34 weeks? That was a full 6 weeks away. What would we do about the boys? I wanted to bawl, but I couldn’t. I was moved to a room in labor and delivery and was told that my first 24 hours would be spent on complete bed rest (not even any trips to the bathroom). I would also not be allowed to eat that first 24 hours until they were sure things had stabilized. By the time I was finally settled in my room, it was around 11pm. I was exhausted and terrified. I kept thinking about the boys at home. I should have been there to tuck them in that night. I had never been apart from them both and I felt like someone had just ripped my heart out. I was worried about this baby who would be premature and I felt sorry for myself too. Our whole plan was out the window. I wasn’t proud of these feelings, but I acknowledged them. I didn’t get much sleep that night. When I did fall asleep, it would be for very short periods of time. When I woke, I cried.

By the next morning, the tears were flowing freely. I couldn’t talk without crying for awhile. I was told that I would have a sonogram that morning, but would not see the perinatologist until Monday, as he was out of the office. I had heard of him before and knew that he was good. The sonogram showed that the baby was sideways but growing fine. Amazingly, the amniotic level was at 14; still normal! I did not have any leaking that day and was encouraged, but the leaking returned that night, with cramping. I was told that I would probably leak the whole time. I had to wear these things around my calves that pumped air and lowered my risk of developing blood clots. I was started on large doses of antibiotics through an IV to lower the risk of infection setting in since I was ruptured. I had my second and final steroid shot that night. Somehow, I was given the strength that day to accept that this was our reality. I knew we would get through this, and I was determined to be as positive as possible.

The next day was Cinco de Mayo. It was also the day of the super moon that year, which unfortunately I could not see through my window. I was disappointed that we would be missing the Cinco de Mayo celebration at church that night. I had been looking forward to taking the boys, as I knew they would enjoy it. However, my husband brought the kids to visit. It was so good to see them! My 2 year old climbed right up in bed with me to snuggle, like always. My 3 year old seemed a little taken aback and quiet. They played throughout the afternoon and had supper with me. They were so excited that they could see the Lifestar helicopter from my window. I was able to get out of bed to go to the bathroom and take a very brief shower that day. I had a new appreciation for the small things in life!

I had almost no leaking that day or night. That evening, while I was praying and trying to keep the fear away, I had a vision that I was walking with Jesus and he took my right hand. It was the most comforting, peaceful feeling. I wished that I could hold onto that forever! Sunday was very uneventful. There was no leaking or cramping.

Monday was roller coaster ride. The nurse came in and told me that I would have a sonogram with the perinatologist that morning, who was back in the office. However, she said that my Doctor was so encouraged by my lack of symptoms that they thought I had sealed over and I would probably be allowed to go home. They just needed the perinatologist’s approval. I couldn’t believe it! I was so excited and thankful. However, when I arrived in the perinatologist’s office downstairs, the nurse asked why I was in a wheelchair and not in a hospital bed. I thought once they did the sonogram, they would see that I was sealed over, but that was not the case. The doctor said that that baby was now head down, which was probably creating a cork-like effect, keeping me from leaking. The nurse told me that there were still pockets of fluid outside the amniotic sac and that I would probably have at least one more big gush. The amniotic fluid level was still on the low end of normal, though, and all her growth was still normal! They estimated that she weighed about 2 pounds, 12 oz, more or less. I decided to be encouraged by that, even though I was disappointed that I would not be going home. I still felt very lucky.

Tuesday morning was a scary one. I had a big gush of blood in the early morning hours. I just remember lots of nurses in the room, calling the Doctor. I passed a very large clot. They put me back on complete bed rest with no eating or drinking all day, just in case. They did a quick sonogram to be sure that the placenta didn’t appear to be separating, and they checked to see if I was dilated (I was dilated to a 1). They kept the baby monitor on for a good 12 hours (normally they put the monitor on twice a day to make sure she wasn’t in distress). It was very soothing to hear her heartbeat while I rested.

On Wednesday things had calmed down again a bit. I was able to eat and drink again but the bleeding continued, so I remained on bed rest. They said they would continue just monitoring things. I looked forward to seeing my husband and the boys on Thursday or Friday.

Thursday was pretty much the same. They continued monitoring the baby twice a day. I remained on complete bed rest. That night after supper, I began feeling a little anxious. My heart seemed to be beating fast. The nurse noticed my heart rate and when I told her how I was feeling, she said it was very normal to feel that way when you’ve been cooped up for so long.

On May 11, 2012, at around 8:00am, the Doctor came and told me that my lab results that morning showed that infection was setting in, and because they didn’t know where all the bleeding was coming from, they would be delivering by C-section in about 3 hours. I called my husband who left work and began the long drive to Topeka. They started me on Magnesium Sulfate. They usually try to give it 12 hours before delivery, but since they had to deliver quickly, they gave a large dose, then went down to a smaller dose for the remainder of the 3 hours. Unfortunately, I got the large dose in, but then felt like my chest and throat were on fire, so they stopped it. I began having contractions that morning as well.

My husband arrived about 5 minutes before surgery, just in time to put on his scrubs. I was glad he was able to make it and could hold my hand throughout the C-section. The operating room looked so different from the last C-section I had. There was a lot of equipment for the baby and a team from the NICU. They assured me that most of the equipment was there “just in case.” During the surgery, I could hear them counting, but I’m not sure what the counting was for. The hypnobirthing that I had been practicing for my big VBAC actually helped keep me relax during the procedure. I was very calm this time around.

Jeremy and I were both surprised when Lucy started crying after she was delivered! They wheeled her around for me to see before she was taken to the NICU. She was so tiny! They told me that she was a good size for 29 weeks, though. She weighed 2 pounds, 13 ounces. Our precious little girl was born one day before Mother’s Day. She stayed in the NICU for 6 weeks but did amazingly well. She never had to be on oxygen, but did stay on a CPAP for her breathing pressures for quite a while. She passed a lot of blood that she had swallowed. They eventually determined that the bleeding was due to placental abruption. I kept a journal of her stay in the NICU.

We are so grateful to have our little girl here with us. She is now a healthy and happy one year old and we can’t imagine life without her. That week in the hospital was the hardest thing I’ve ever had to go through, but it taught me more and caused me to grow in ways I never imagined. It’s been so therapeutic to write down my experience. For months I felt like I was stuck in May of 2012. I felt (and still do feel) things more acutely than I ever have.

I am so thankful that the angels were surrounding us that week and for all the prayers and support. We are also thankful for all the skilled doctors and nurses and all the medical advancements that have been made.

Monday, May 5, 2014

What do postpartum parents want? Part 3

I've compiled another "Postpartum Wishlist" for your perusal, listing requests and thanks for support shared by parents who've given birth or who are preparing to. As usual, I find these candid answers to be incredibly illuminating.

See parts one and two for more responses.

Q. What kind of support did you need or want from a postnatal doula or other postnatal helper, if you had one? What kind of support would you hope for if you were to hire one in the future?

Cook me breakfast!

I didn't have a postpartum doula, but I would have paid anything just to take a daily shower that lasted more than two minutes, and to do some light cooking and light housework while I breastfed baby. Having a newborn baby at home is the worst time to be drowning in dust and unswept floors.

Just sit and listen and talk. What a new mother needs more then anything is someone to listen to her, especially to help her process her birth, and someone to give her positive feedback.

I wanted time for a shower and to get other things done, so my doula held the baby while I did that.

I needed emotional support and just the company of another person. 

My postpartum doula was awesome. The most useful things she did were to talk to me, be there for me, help me feel what I am doing and thinking and feeling is 'normal' and on the right track, and to model some good, practical techniques (like swaddling) for me. She also cooked a huge vat of lentil soup that kept us going for days. She rocks!

After I had my baby, I loved helpers cooking for me, watching my older kids so I could nurse/sleep in peace, and cleaning my kitchen.

I'd love a doula to help with placenta encapsulation or recipes for eating it.

I had a doula. It was great to be able to talk with someone who understands what I was going through, helping me round the house and picking my older kids up from school once a week. I also got great lactation advice from her.

Talk and debrief about my birth experience, be a shoulder to cry on, assist with breastfeeding, wash the dishes, wash clothes, vacuum, cook, tell visitors to leave or come later if I'm resting, organize appointments, tidy up, entertain older children for a short time... 
 I would have liked some actual help around the house -- dishes, laundry, cooking, holding baby so i can poop, etc. I wanted someone I could express my overwhelming feelings to, someone who would console me or tell me it would get better or do something concrete to help the immediate situation.  

I only had a labor doula. I was lucky enough to stay with family. My MIL and my mom provided all the meals and my hubby was really great. He went back to work after 1 week, though, so that was hard. I do wish I had had someone warn me what it was going to be like after having the baby. I was in shock. I guess I should have used my common sense, but it never occurred to me that I was going feel like I had been run over by an eighteen wheeler. I wish I had had someone who had good natural remedies for the pain and swelling. My husband did a great job making my baths for me, helping me get dressed, bringing me ice packs or anything I needed, watching the baby so I could nap or bathe. He even helped with getting the baby to latch! Had he not been there, and also for the days after he went back to work it would have been great to have a postnatal doula to help with those things. I can imagine needing help with the older kids too, if there are any. 

I desperately needed someone to tell me I was doing fine and to stop panicking... And to distract me while I was breastfeeding.

Preparing food and clean up afterwards is most important to me... Is 6 months TOO postpartum to hire one?? LOL. 

We had our babies at home, and the doula came the next day and raised the bar for my husband, who does not cook, as to what a meal for a woman who has had and is nourishing a baby should look, not cereal and rice milk AGAIN. She brought and prepared in my kitchen grilled salmon, wild rice with toasted almonds, sautéed spinach. She then massaged my back and shoulders so I could relax, cleaned the whole kitchen, took out the trash, folded the laundry and quietly left us to truly rest. Very professional financial arrangements. She was an ANGEL! The world needs more like her! 

Bonus: A postpartum doula speaks!  What does she think her clients need and want?

In my work as a postpartum doula, I offer light housework and cooking as part of the package. I like to help parents grocery shop for lots of fresh veggies, then cook a big pot of some all-in-one dish like veggie-spaghetti and freeze it for them in portion-sized containers, so they have several weeks of go-to food that's healthy, organic, homemade, and has the nutrients that a birth parent especially needs, like added iron and fiber and things like that.
I figure my job is also to make sure that parents and baby are healthy and bonding. The house needs to be clean (but not spotless). There needs to be plenty of clean laundry and good food available, and basic supplies. I usually teach various swaddling tricks, help my client get a good latch, etc. I have connections with so many people who can troubleshoot feeding or other issues that I can get an answer fast for any problem.
Most importantly of all, I constantly reassure the new parents that they are doing all right. New parents may worry about everything, from the size of the diaper to the state of the cord stump. Those little details are usually really flexible, but it takes awhile for parents to learn how to trust their instincts, and I just keep helping them see that they're doing great -- asking them what their guts are telling them, and reinforcing their own instincts (which are usually right on).
When I leave, I want parents to be totally empowered. They're all caught up with chores, they have plenty of good meals available, and they have eased into life with the new baby. They feel confident in their abilities to make decisions, and they have learned to trust that little voice that says, "This is what my baby and I need right now."

I will be asking more postpartum doulas to share their favorite ways to help families. Look for that in a future post.


Postnatal families deserve support! Discussions like this make me excited about offering my services to another family soon. The shape of a particular client's need informs and shapes my work, so I am always learning and growing as a caregiver.  What would help look like to you?

(Quotes above have been edited for clarity and to preserve anonymity)